Healthcare Provider Details

I. General information

NPI: 1811194285
Provider Name (Legal Business Name): HAVEN HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W CABARRUS ST
RALEIGH NC
27603-1953
US

IV. Provider business mailing address

600 W CABARRUS ST
RALEIGH NC
27603-1953
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-3312
  • Fax: 919-833-3512
Mailing address:
  • Phone: 919-833-3312
  • Fax: 919-833-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ADRIANNE ELLIOTT
Title or Position: ACCOUNTING TECHNICIAN
Credential:
Phone: 919-833-3312